Whats your opinion on PAs?

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Pretty low risk. pa pays doc 500 dollars/month or so and buys them their own malpractice policy. they answer very occassional questions by phone during business hrs.
anyone really sick goes to the er so the doc not involved. on site requirement = 30 min every 6 months for a lunch meeting. 6000 dollars a yr for no work with a 3 million dollar malpractice policy thrown in....lots of folks would( and do) say yes to that.
if docs didn't sign up for this it just wouldn't work, but yet it does.

is this like pro-plaintiff malpractice witness doctors where there are aren't many of them but they do this a lot? are there guys that just supervise like 15 of these PAs?

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Im willing to predict that the only one who gets more attention on this page than a P.A. is an obese medical student (basically because 65% of the population is overweight)
 
is this like pro-plaintiff malpractice witness doctors where there are aren't many of them but they do this a lot? are there guys that just supervise like 15 of these PAs?

NOPE- for the most part it's docs consulting for 1 practice for a pa they know well, have worked with before, and trust impilicitly. there are practices that advertise for a doc they don't know but this is a less than ideal situation.
in some situations the solo pa owns the practice, in others the pa works solo at at a satelite clinic owned by a doc.

"Im willing to predict that the only one who gets more attention on this page than a P.A. is an obese medical student"

because there are more morbidly obese med students than obese pa students.....
 
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It didn't take long for this thread to degrade. Why is it that every month a thread like this shows up? The same points are bantered around. We need to sticky the best thread.
 
NOPE- for the most part it's docs consulting for 1 practice for a pa they know well, have worked with before, and trust impilicitly. there are practices that advertise for a doc they don't know but this is a less than ideal situation.
in some situations the solo pa owns the practice, in others the pa works solo at at a satelite clinic owned by a doc.

Ok, so that doesn't go along with what you said earlier. $6000/year, and physicians (if they are dumb enough to sign on to this) have only 1 PA under their belt. $6000 is nothing compared to the average salary of an established physician. There obviously must be something else going on, some other incentive... financial or otherwise... because "implicit trust" in someone or friendship or something is so not sufficient for risking one's license, at least not for me.
 
""implicit trust" in someone or friendship or something is so not sufficient for risking one's license, at least not for me"

6000 dollars for no work and minimal risk is a great deal.if a doc has worked with a pa daily in clinic for years and trusts them there is no reason for this arrangement not to work for both parties. it's win/win. rural community gets a provider they wouldn't otherwise have. pa gets to work to the full extent of their LEGAL scope of practice. doc gets 6000 dollars and 2 free lunches a yr.
if you don't like it don't move to north carolina and work with pa's. there are plenty of other docs who will so they don't really need you or those who think like you do.....
ps .... chairmen of the north carolina state medical board have been pa's and the docs there don't seem to have a problem with that either, seeing as they elected the pa's to that position.....
 
At least PA's know their place, it's in their title. Rant over :oops:)

The PAs in Ohio certainly didnt "know their place." They got a law passed eliminating any doctor oversight in hospital settings.

That sounds like big time ambition to me, not people "knowing their place"
 
Pretty low risk.

Pretty low risk my ass. The MD is responsible for just about everything the PA does while the MD is hundreds of miles away, never seeing the patients, etc.

Dont think for a sec that if the PA screws up (Yes PAs screw up just like MDs) that the MD wont be named in the suit.

Its an incredibly high risk arrangement for the MD, those idiot MDs are playing with fire and I hope they all get sued.
 
Uh oh, MacGyver and emedpa in the same thread! <runs for cover>
 
Pretty low risk my ass. The MD is responsible for just about everything the PA does while the MD is hundreds of miles away, never seeing the patients, etc.

Dont think for a sec that if the PA screws up (Yes PAs screw up just like MDs) that the MD wont be named in the suit.

Its an incredibly high risk arrangement for the MD, those idiot MDs are playing with fire and I hope they all get sued.


The Malpractice Experience: How PAs Fare
--------------------------------------------------------------------------------
An employer often wants to know in advance whether adding a PA to a practice will reduce or increase the malpractice risk for a supervising physician, practice, or institution. Producing data that substantiate either point of view is difficult.

Information from the National Practitioner Data Bank (NPDB) reveals that PAs incur a remarkably low rate of malpractice judgments. Moreover, other data support the possibility that hiring a PA may reduce the risk of malpractice liability. These data are especially powerful when compared with studies suggesting that neither the quality of care nor the quality of chart documentation can account for the differences between sued and never-sued providers.[1,2]

The Facts
The Health Care Quality Improvement Act, passed by Congress in 1986, requires that all malpractice payments (losses, paid claims) made on behalf of any clinician a state licenses, registers, or certifies must be reported to the NPDB. Since the data bank began collecting statistics in 1990, it has recorded a total of 100,750 paid claims for all physicians of every type, with an average paid claim of $188,773. During the same period, the NPDB recorded a total of 240 paid claims for PAs, with an average paid claim of $83,625.[3]

Perspective on these data can be gained by noting that, in 1998, an estimated 272.8 physicians and 11.7 PAs exist for every 100,000 people; 23.4 physicians exist for every PA in this country. We can surmise that, all other things being equal, the number of physician-related paid claims is 23.4 times that of PA-related paid claims. In reality, the number of physician-related paid claims approaches 420 times that of PA-related paid claims. A further disparity is noted when mean losses are compared over this period: Mean physician-related losses are 2.26 times greater than PA-related losses.

Another way of examining the differences between the malpractice experience of PAs and physicians is to calculate how many providers of each type exist for each malpractice claim. Data from 1996 show that one claim was paid for every 46.6 physicians and one for every 808.1 PAs.

A similar disparity was revealed when the total number of dollars expended in all physician-related paid claims were compared with all PA-related paid claims. During the entire period that the NPDB has been collecting data, the total for physicians was 946.6 times the total for PAs.

That PAs affect a practice’s liability one way or another is not indisputable on the basis of the evidence; the NPDB data show, however, that a relatively small number of malpractice payments are being made on behalf of PAs.

Impact of PAs on Malpractice Claims
Studies show that effective communication with patients is the best way to avoid a malpractice suit.[4-6] PA education has always focused on interviewing skills and techniques to improve communication — two skills that can enhance any practice.

Since early in the PA profession, it has been speculated that a PA could reduce the risk of malpractice judgments because the PA’s presence allowed the supervising physician to concentrate on more complicated cases. It is assumed that employing a PA reduces waiting time and provides patients with greater attention, which enhances patient rapport and satisfaction. Recent studies show that scheduling enough time to talk with a patient in the examining room and to answer telephone calls personally and promptly lowers the risk of malpractice claims.[7]

Adding a PA to a practice may prevent patients from feeling rushed or deserted during an office encounter.[8] These observations emphasize that what a clinician says may be less important the tone and process of the visit in predicting malpractice claims.[1] One commentator observed: “Good communications skills are not only good medicine — they are good for the bottom line.”[9] Interviewing and communication skills probably translate, over the long run, into fewer malpractice suits and reduced fees for professional liability insurance.

The Priority is Quality Care
As changes in health care delivery force shorter patient visits and other restraints on care, one hopes that PAs’ traditional strengths as excellent clinicians and communicators will continue to validate a conviction expressed early in the history of the profession by the American Medical Association’s assistant general counsel: “PAs probably hold the potential for being one of the best malpractice tools available....”[10]


REFERENCES
1. Levinson W, Roter DL, Mullooly JP, et al. Physician-patient communication: The relationship with malpractice claims among primary care physicians and surgeons. JAMA 1997;277(7):553-559.
2. Shapiro RS, Simpson DE, Lawrence SL, et al. A survey of sued and nonsued physicians and suing patients. Arch Intern Med 1989;149(10):2190-2196.
3. The National Practitioner Data Bank Research File of September 30, 1997, as maintained by the Division of Quality Assurance, Bureau of Health Professions, Health Resources and Services Administration, US Department of Health and Human Services.
4. Lester GW, Smith SG. Listening and talking to patients. A remedy for malpractice suits? West J Med 1993;158(3):268-272.
5. Kaplan SH, Greenfield S, Gandek B, et al. Characteristics of physicians with participatory decision-making styles. Ann Intern Med 1996;124(5):497-504.
6. Frankel RM. Communicating with patients: Research shows it makes a difference. AAPA NEWS 1995;16(2):8.
7. Charles SC, Gibbons RD, Frisch PR, et al. Predicting risk for medical malpractice claims using quality-of-care characteristics. West J Med 1992;157(4):433-439.
8. Beckman HB, Markakis KM, Suchman AL, et al. The doctor-patient relationship and malpractice: Lessons from plaintiff depositions. Arch Intern Med 1994;154(12):1365-1370.
9. Trafford A. When paying medical bills, how about a tip for caring? The Washington Post March 25, 1997, p. 206.
10. Ryser J. Claims rate low: PAs seen as asset in liability crisis. Am Med News 1976;April 26:1,11-12.
 
No, this is where you as the med tech did not respect the hierarchy of patient care at a teaching hospital. The resident has an MD, and can deal with sepsis, and should be the one calling the attending if something is urgent. You are out of line, and in fact disrespectful to the resident's status, if you call the attending physician directly if the established route of escalation is through the resident. I suspect that this is also why the attending physician was pissed.

Also, perhaps the attendings were upset because they can't give orders to a med tech. The labs in the hospitals where I've worked always called the floor and notified nursing of critical lab values. It was the responsibility of nursing staff to call the attending with the values and then take whatever orders were needed.

Sorry, that was slightly OT...
 
The Malpractice Experience: How PAs Fare
--------------------------------------------------------------------------------


WTF? I'm hardly anti-PA but that may be singlehandedly the worst article I have ever read. Attempting to draw conclusions on rates of PA malpractice suits by comparing the ratios of PAs to PA lawsuits versus MDs to MD lawsuits??? Minor issues with that: the fact that PAs are more concentrated in low liability fields (FP), the fact that many PAs do not have independent clinician duties that would cause them to be as frequently liable in a malpractice suit (most specialties besides FP and EM) and a bunch of other things spring to mind. And then asserting that PAs probably lower MD malpractice without ANY evidence (I bet the MDs just add more patients to the practice and expect PAs to crank them out just as fast, rather than add more time per patient). What an awful piece.
 
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Why are you guys focused just on PA's? They're hardly the only threat. Let's not forget about NP's, DNP's, and CRNA's. The governor of PA wants to expand health coverage by expanding the authorities of midlevels. Like it or not, midlevels will be used by politicians to fill the gap in healthcare. We as physicians have to move up the foodchain.
 
WTF? I'm hardly anti-PA but that may be singlehandedly the worst article I have ever read. Attempting to draw conclusions on rates of PA malpractice suits by comparing the ratios of PAs to PA lawsuits versus MDs to MD lawsuits??? Minor issues with that: the fact that PAs are more concentrated in low liability fields (FP), the fact that many PAs do not have independent clinician duties that would cause them to be as frequently liable in a malpractice suit (most specialties besides FP and EM) and a bunch of other things spring to mind. And then asserting that PAs probably lower MD malpractice without ANY evidence (I bet the MDs just add more patients to the practice and expect PAs to crank them out just as fast, rather than add more time per patient). What an awful piece.

That seems probable since they need to be able to afford the PA in the first place, so they will need to increase the number of patients.

I worked at a clinic not too long ago that had 2 PA's on staff. Many of the patients referred to them as "doctors" and were never corrected, be it because they like to believe they are doctors (I really think this is a big one) or because admitting to their patients they are not "real" doctors would cause the patients to lose confidence in them, despite the fact that the patients absolutely loved them and requested to see "Dr. X" specifically (the Dr. X being one of the PA's).

The way I saw it at this particular clinic, having the PA's only meant the clinic could have more patients, NOT give their existing patients more time. Patients still had to wait 1+, 2+, or more hours in the waiting room, not counting the time spent waiting in the examination room. The only way to get in right away is to arrive at the clinic 1-2+ hours before it opens, or be related to one of the staff members who could push your file to the front of the stack. On average, doctors/PA's spent 10-15 minutes in the examination room (less if the problem was obvious), 10 minutes filling out paperwork, and 1-2 minutes handing out and explaining a prescription.

The only advantage I see to have a PA is to increse the revenue of a medical practice, as they get paid somewhat less than a primary doctor and can increase the number of patients the clinic can see. I dare say double or triple it, as they get all the easier cases that don't really take up that much time.
 
Why are you guys focused just on PA's? They're hardly the only threat. Let's not forget about NP's, DNP's, and CRNA's. The governor of PA wants to expand health coverage by expanding the authorities of midlevels. Like it or not, midlevels will be used by politicians to fill the gap in healthcare. We as physicians have to move up the foodchain.

so does dr moritsugu, the surgeon general of the u.s.
he is on the national pa foundation board of directors and has been for years....he's on our side.....
he significantly increased the visibility, authority, and utilization of pa's in the us public health service and continually looks for ways to utilize pa's to their fullest extent. he recently promoted a pa to the rank of admiral in the public health service, the 1st pa to reach flag rank in any service. a good friend of mine will probably be the 1st 1 star general in the us army medical corps in the next few yrs.
 
When the automobile first came out, the carriage makers who refused to accept the future bit the dust.
 
When the automobile first came out, the carriage makers who refused to accept the future bit the dust.

The automobile was a better version of the carriage, though, and I am not sure that analogy applies to PAs:MDs.
 
emed is blissfully unaware of how little relevance the article he posted is relevant to my claim.

i'll give him some more time to think about why his article has nothing to do with my statement.
 
Why are you guys focused just on PA's? They're hardly the only threat. Let's not forget about NP's, DNP's, and CRNA's. The governor of PA wants to expand health coverage by expanding the authorities of midlevels. Like it or not, midlevels will be used by politicians to fill the gap in healthcare. We as physicians have to move up the foodchain.

Yes, I've been trying to tell them. There are other mid level practioners.
Nurse midwife also. Many docs want the more lucrative and flambouyant specialties. So fight them also! [P.A. is physician dependent and physician friendly]
 
Also, perhaps the attendings were upset because they can't give orders to a med tech. The labs in the hospitals where I've worked always called the floor and notified nursing of critical lab values. It was the responsibility of nursing staff to call the attending with the values and then take whatever orders were needed.

Sorry, that was slightly OT...


Yes, I did that too when I was working as a med tech. I'd be calling in critical values and reporting them to either the doctor or his/her nurse.
 
As a med tech, I've tried to call attendings before with critical lab values. They yell at me, tell me I'm supposed to call the resident. Their time is too valuable. Too valuable, I say? Well aren't YOU the person who is ultimately billing the patient? To me that sounds a lot like selling out too. Have your residents deal with all of your patients and don't waste time acting when your patient might be septic even when you are supposed to be the doc in charge.


I worked as a med tech for 6 years . I never had the problem of anyone getting upset with me for calling in a critical value.

And yes, an anon-mouse pointed out, sepsis should be easy to treat by the resident. He'll probably just have the patient take some anti-biotics and orange juice.
 
Not sure what this thread deteriorated into.

I am a practicing registered med tech who was a PA school reject, and I am a current MS 1. There are some med techs who support PA's wholeheartedly. (Plus I don't do any filing, operating a pulse ox, or pill passing, sorry--did do that stuff as a nurse tech though).

I just didn't want others to feel like med techs are united in their opposition to distinct groups of medial practitioners.


Yes, I am registered too; MT(ASCP). I apologize for sounding too harsh towards PA's
 
I'm not quite sure if you're deliberately being obtuse or if you're trying to be funny. I am a PA who used to be an MT.

A medical technologist and a medical assisstant are divergent fields.

A medical technologist is a bachelors degree in laboratory science. We take most of the same pre-reqs as medical students and take classes to include clinical chemistry, hematology, immunology, biochemistry, molecular biology, coagulation, UA and body fluids, immunohematology, parasitology, etc.

All of the lab tests you order are the ones we perform or supervise being performed.

What's that you patient has a hemolytic anemia or heriditary spherocytosis or a warm-autoantibody, we'll work them up. Oh, do they have TB or coccidiomycosis, we'll work them up. Oh, you need someone to identify the species of malaria your patient has, we'll do that. You need someone to identify what bug your patient has, that'd be Vibrio vulnificus. What, you think they might have AIDS, who's gonna do that western blot for you.

You get the idea! I don't ever recall handling a pulse-ox as a med tech, although I do remember doing QC on a coulter counter worth a few million.

You really might want to learn something about the professionals who help make things happen in the medical field. I'm sure that you think there is some black box in the sky that spits out lab results. However, there is more than you will ever know that goes into all of that stuff behind the scenes and that will make your job possible in the future. There are also a lot of dedicated professionals who get damn little credit for all that they do!

-Mike


thanks man! :thumbup: It's true, sometimes med techs don't get the credit we deserve. At least the salary is decent in most states
 
If nothing else, like Howard Stern. Your post willl make a lot of people laugh real hard. Also no one can flame you because the guy said speak positively or negatively about P.A.s!!


Thank you! Yes, the person who started this topic did say to post any comments we have about PA's, either negative or positive
 
I worked as a med tech for 6 years . I never had the problem of anyone getting upset with me for calling in a critical value.

And yes, an anon-mouse pointed out, sepsis should be easy to treat by the resident. He'll probably just have the patient take some anti-biotics and orange juice.

Yeah as I pointed out before, my hospital's policy is to never give crit's to a nurse. For ped's or pt's with zebra bug histories, I MUST call the attending or be fired. I'm not dissing any military hierarchy that has been established, just doing my job. We just run a very conservative place with looming ID docs. I've worked at other places where it is kosher to call nurses, but I should not be yelled at for obeying hospital policy.

At my current place (a teaching hospital), residents hear "Gram positive cocci in clusters" and automatically go to the vanc. This drug is expensive per our formulary, tough on your system, and IV only; yet they give it even when it's just one out of four bottles and drawn where the bottles get routinely contaminated. Most of the time, it comes back as coag neg in 1/4, yet the resident often doesn't have time to consider whether the pt is spiking or how long the bottles have been in the incubator. From the lab standpoint, you're just putting the patient at higher risk for VRE and later on VRSA when that monster becomes commonplace. These are not usually cases where the attending must be notified, but if I'm the pt, I don't want the vanc with 1/4 positive if I'm showing no fever, military hierarchy or not. I want the guy who my insurance company is paying to step in and save my kidneys the discomfort. No need to wipe our my colon for no reason. I may want that Vitamin K later on to make some clots.
 
Yeah as I pointed out before, my hospital's policy is to never give crit's to a nurse. For ped's or pt's with zebra bug histories, I MUST call the attending or be fired. I'm not dissing any military hierarchy that has been established, just doing my job. We just run a very conservative place with looming ID docs. I've worked at other places where it is kosher to call nurses, but I should not be yelled at for obeying hospital policy.

No, you said earlier that you had to call the attending over the RESIDENT (who is most obviously a physician as well), not over the nurse. I wonder which teaching has the hospital policy that a lab tech should override the *resident physician* on duty for the patient and go directly to the attending...

Obviously you would bypass the nurse in that sort of urgent situation.
 
""implicit trust" in someone or friendship or something is so not sufficient for risking one's license, at least not for me"

6000 dollars for no work and minimal risk is a great deal.if a doc has worked with a pa daily in clinic for years and trusts them there is no reason for this arrangement not to work for both parties. it's win/win. rural community gets a provider they wouldn't otherwise have. pa gets to work to the full extent of their LEGAL scope of practice. doc gets 6000 dollars and 2 free lunches a yr.
if you don't like it don't move to north carolina and work with pa's. there are plenty of other docs who will so they don't really need you or those who think like you do.....
ps .... chairmen of the north carolina state medical board have been pa's and the docs there don't seem to have a problem with that either, seeing as they elected the pa's to that position.....

$6000 to an established physician making $300,000 is 2% of his salary. Even if he were making just $200,000, that's 3% of his salary. That is PEANUTS, a drop in the bucket. And if something should happen to go severely wrong, there will be absolutely no question that the physician will be named in the lawsuit. Now, if $6000 was nothing compared to a $200k salary, then think of how much it is compared to the drastically increased insurance premium, other associated costs, etc... and of course the black mark of having judgments against the physician on the record.

I hope there's someone at Duke or UNC reading this, who now realizes what a horrible proposition this is... signing away your medical license (or soul).
 
Yeah as I pointed out before, my hospital's policy is to never give crit's to a nurse. For ped's or pt's with zebra bug histories, I MUST call the attending or be fired. I'm not dissing any military hierarchy that has been established, just doing my job. We just run a very conservative place with looming ID docs. I've worked at other places where it is kosher to call nurses, but I should not be yelled at for obeying hospital policy.

At my current place (a teaching hospital), residents hear "Gram positive cocci in clusters" and automatically go to the vanc. This drug is expensive per our formulary, tough on your system, and IV only; yet they give it even when it's just one out of four bottles and drawn where the bottles get routinely contaminated. Most of the time, it comes back as coag neg in 1/4, yet the resident often doesn't have time to consider whether the pt is spiking or how long the bottles have been in the incubator. From the lab standpoint, you're just putting the patient at higher risk for VRE and later on VRSA when that monster becomes commonplace. These are not usually cases where the attending must be notified, but if I'm the pt, I don't want the vanc with 1/4 positive if I'm showing no fever, military hierarchy or not. I want the guy who my insurance company is paying to step in and save my kidneys the discomfort. No need to wipe our my colon for no reason. I may want that Vitamin K later on to make some clots.

Yes, a few coag factors are vitamin K dependent, but orange juice has vitamin C.

Anyways, I don't think it's your call to decide who gets Vancomycin or not. I don't know how you work up blood cultures in your lab, but when I worked in micro, we got two bottles, one for aero and one for anaero. We plate, incubate, and work up any positive bottle.

how can you predict if someone is going to get vanc resistance enterococcus/staph aureus?

and yes, a lot of time, we get CNS, but that's is because a lot of normal skin flora contaminants are CNS.

Anyways, when I was a praticing med tech, I ran the tests, make sure the results are reliable and accurate, and then report them. Simple.


I don't think it's the med tech's job to worry about what medication the patient might recieve or insurance payments.
 
No, you said earlier that you had to call the attending over the RESIDENT (who is most obviously a physician as well), not over the nurse. I wonder which teaching has the hospital policy that a lab tech should override the *resident physician* on duty for the patient and go directly to the attending...

Obviously you would bypass the nurse in that sort of urgent situation.

Yes, at my place, I go over both the resident and the nurse for all ped's cases and adult cases that meet our criteria. And I'm not a lab tech. Residents often call me for expertise in prescribing antibiotics because I am educated, trained, and certified in clinical microbiology and molecular pathology by the ASCP and working under the supervision of a pathologist (who incidentally I helped train before he became an attending). While many med students have to use the traditional "cram and forget" approach for their medical micro only to have to live by pocket antibiotic guides as interns years later, I actually know that stuff already. So don't call me a lab tech as if you are superior to me. It's pretty clear that your reasons for going into medicine are different from mine.

Yes, a few coag factors are vitamin K dependent, but orange juice has vitamin C.

Anyways, I don't think it's your call to decide who gets Vancomycin or not. I don't know how you work up blood cultures in your lab, but when I worked in micro, we got two bottles, one for aero and one for anaero. We plate, incubate, and work up any positive bottle.

how can you predict if someone is going to get vanc resistance enterococcus/staph aureus?

and yes, a lot of time, we get CNS, but that's is because a lot of normal skin flora contaminants are CNS.

I don't think it's the med tech's job to worry about what medication the patient might recieve or insurance payments.

Yes we are very worried about controlling costs and insurance reimbursements. The hospital makes its formulary (which dictates what the lab reports) based on medication cost, and we are very concerned about running unnecessary tests because insurance won't cover them.

And yes, we do need to be worried about what is being prescribed because we report to infection control who has to do something when we get too much VRE. That stuff will literally keep you out of a nursing home, and it is the lab's job to make biograms that show what are facility's resistance rates are. How can we predict when somebody's going to get VRE? It usually starts when they get IV vanc when they didn't need it.

We plate everything, but not all organisms get a work up per worldwide CLSI guidelines. CLSI standards have gotten stricter because of over-treatment of stuff that shouldn't be treated.

You are right. It's not my call as a med tech to decide who gets vanc. That's why I decided to change careers. In the interim, however, I believe that the methods in which residents are trained make them the type of provider that I don't want to see. So as a result, I prefer to see PA's for primary care, and I don't let residents operate on me during surgery. It's just a preference based on my own experience.
 
The public just sees a white coat and thinks doctor. The rest is just alphabet soup to them. They don't process MD/DO/PA/med student/etc. If an orderly came in in a white coat folks would probably give him a full history and let him do a physical exam on them.


I agree 100%.
 
We plate everything, but not all organisms get a work up per worldwide CLSI guidelines. CLSI standards have gotten stricter because of over-treatment of stuff that shouldn't be treated.

You are right. It's not my call as a med tech to decide who gets vanc. That's why I decided to change careers. In the interim, however, I believe that the methods in which residents are trained make them the type of provider that I don't want to see. So as a result, I prefer to see PA's for primary care, and I don't let residents operate on me during surgery. It's just a preference based on my own experience.

Yes , of course, we don't work up every single organism. That's ridiculous. That would take forever. Like you said, we plate everything, but we only work up the predominant colonies. If there are 3 or more predominant colonies present, we usually ask for re-collection. Because 3 or more species is usually caused by contamination/improper collection.

I like to think I am not changing careers, but I am enhancing the one I got. I plan to become a pathologist after med school. In a way, I'd like to think we medical technologist are mini-pathologists :) .
 
My opinion of PAs was completely soured by one particularily amusing introduction to 'other medical providers'.

Lecturing Physician Assistant to First year medical students: You need to remember that during those years you went to medical school and through residency we were out actually working. So we will know more than you do at the end of your residency.

Backrow Medical Student to Lecturing Physician Assistant: Bull****

After actually being out on the wards I know that most PAs don't have this cocky of an attitude and are an invaluable part of the healthcare team. Most of the PAs and PA students I've worked with have been great. However, I've run across a couple PA students who definately had a weird tension about how they were just the same as medical students. Both groups are students, both important, but they are definately not the same.
 
Both groups are students, both important, but they are definately not the same.
At a few PA progarms, PA students take the classes with medical students. So maybe they're not the "same", but for many, their basic knowledge base IS the same.
 
At a few PA progarms, PA students take the classes with medical students. So maybe they're not the "same", but for many, their basic knowledge base IS the same.

I'm gonna have to call BS on this one.

We function a lot alike and in some programs we do take some of the exact same courses and are treated exactly the same on the wards during clinical rotations.

In fact, I'll go further to say that we sometimes match up, clinical skills wise, at the end of all of our rotations. This is due to the fact that med school education is heavily into basic sciences, wheras PA education is mainly oriented towards clinical skills.

However, our basic knowledge base in no way compares to a typical med student. We don't take hardcore biochem, histology, etc.

Anecdotally, when I was on rotations with med students and we had conference, most of the attendings and med students were impressed with our clinical knowledge base. However, steer of into biochemical pathways for a few minutes or genetics and most of the PA students were aware that we were way out of our league.

This was true for me as well and as a former med tech, I had taken classes on biochem, molecular biology, clinical chemistry, hematology, etc.

Let some of the former PA's turned med students chime in on this one, but IMHO we just do not even come close to being equal in our basic knowlege base.

-Mike
 
I'm gonna have to call BS on this one.

We function a lot alike and in some programs we do take some of the exact same courses and are treated exactly the same on the wards during clinical rotations.

In fact, I'll go further to say that we sometimes match up, clinical skills wise, at the end of all of our rotations. This is due to the fact that med school education is heavily into basic sciences, wheras PA education is mainly oriented towards clinical skills.

However, our basic knowledge base in no way compares to a typical med student. We don't take hardcore biochem, histology, etc.

Anecdotally, when I was on rotations with med students and we had conference, most of the attendings and med students were impressed with our clinical knowledge base. However, steer of into biochemical pathways for a few minutes or genetics and most of the PA students were aware that we were way out of our league.

This was true for me as well and as a former med tech, I had taken classes on biochem, molecular biology, clinical chemistry, hematology, etc.

Let some of the former PA's turned med students chime in on this one, but IMHO we just do not even come close to being equal in our basic knowlege base.

-Mike

I agree with what you said. Med students definitely get more basic science training and testing, and I know many attendings at my place who have said that PA students are better prepared for clinic when they start their rotations.

I'll throw this in just for grins, though. Take a primary care PA with 20 years of experience in practice and a family med doc with 20 years of experience in practice. If you took groups of fifty each, who would you bet on to perform better on a basic science exam? My hunch is that they'd be equivalent, but since in my state the PA's have to re-test every seven years to keep their C, I just might bet on the PA's.
 
I agree with what you said. Med students definitely get more basic science training and testing, and I know many attendings at my place who have said that PA students are better prepared for clinic when they start their rotations.

I'll throw this in just for grins, though. Take a primary care PA with 20 years of experience in practice and a family med doc with 20 years of experience in practice. If you took groups of fifty each, who would you bet on to perform better on a basic science exam? My hunch is that they'd be equivalent, but since in my state the PA's have to re-test every seven years to keep their C, I just might bet on the PA's.

I could see the possibility.

Although, I still think if it happend it would be the above average PAs and below average docs in the group that would account for it.

-Mike
 
This may have been mentioned, but in my opinion, having worked with both PA's and NP's in my prior career. I'd take a PA anyday. They are trained similar to physicians by physicians most of the time. NP's are trained soley by nurses....Oh and this may be news to most of you, did you know that many FNP programs are applying to have their degrees changed to a doctorate instead of a masters level. That's right they want us to call them Dr. or Dr. Nurse, don't know how that will go. Someone should just tell them, if you want to be a Dr. go to medical school, and quit walking around with your second rate community college NP playing Dr.

Let me preface with I will start med school in the fall and can speak from first-hand comparative experience then. I helped my wife study through nursing school and FNP school and we still have the books/tests to compare what is taught.

1. My wife is an NP and did rotations under docs as well as NPs.
2. The original PA programs originally wanted to use RNs but the nursing boards wouldn't allow it, they later changed their minds and started NP programs.
3. Changing a program from masters level to doctorate level will be better for healthcare in the long run. For those of you think that PAs and NPs don't have enough training hours to do the job, this is a good thing: more hours = more training, perhaps PA programs should do the same.
4. While premeds are learning the minute details of organic chem that they will never use beside the MCAT, nursing students are learning practical pharmacology (drug interactions, contraindications, etc.) and then in the masters (doctorate) program they get another more detailed pharmacology course.
5. I know of no community colleges who grant masters in nursing practice or even bachelors in nursing for that matter (although I am sure there are some that have bachelors programs).

For those of you who want to understand market dynamics, you should read The Innovator's Dilemma as it details how those in the high end of markets (MDs in this case) move higher for better margins and those in lower end (PAs/NPs) move in to take their place. Why doesn't IBM make laptops anymore...better money being business advisors to tech companies and Toshiba, Dell, and others moved in to fill the gap.

It is a fact that the FP physician will be usurped by the PAs/NPs eventually. And don't think that the government will keep them from it as a result of lobbying. Legislators have to keep the cost of healthcare down and will do whatever is necessary in the long run (see the post about Ohio PAs).

Moral of the story: Don't go into family practice if you want the "prestige" of being a "doctor" as probably within the span of your career (think 20-30 yrs) you will be seen as equal to PAs and NPs in that field.
 
I agree with what you said. Med students definitely get more basic science training and testing, and I know many attendings at my place who have said that PA students are better prepared for clinic when they start their rotations.

I'll throw this in just for grins, though. Take a primary care PA with 20 years of experience in practice and a family med doc with 20 years of experience in practice. If you took groups of fifty each, who would you bet on to perform better on a basic science exam? My hunch is that they'd be equivalent, but since in my state the PA's have to re-test every seven years to keep their C, I just might bet on the PA's.

Hmm... basic science maybe. But, do PA students get training in Pathology and Pathophysiology (or as much training)? I don't think they do (correct me if i'm wrong). And I'm sure their pharmacology training is not as in depth. So, although they may perform better on basic science they probably wouldn't be able to figure out the details of ie. cardiac tamponade. By this i mean they will know how it presents and treatment options, but not exactly what's going on in the heart at the time. I hope this is the case, otherwise there would not be much separation between MDs and PAs and those many extra years of training are just nil. :thumbdown:
 
Let me preface with I will start med school in the fall and can speak from first-hand comparative experience then. I helped my wife study through nursing school and FNP school and we still have the books/tests to compare what is taught.

1. My wife is an NP and did rotations under docs as well as NPs.
2. The original PA programs originally wanted to use RNs but the nursing boards wouldn't allow it, they later changed their minds and started NP programs.
3. Changing a program from masters level to doctorate level will be better for healthcare in the long run. For those of you think that PAs and NPs don't have enough training hours to do the job, this is a good thing: more hours = more training, perhaps PA programs should do the same.
4. While premeds are learning the minute details of organic chem that they will never use beside the MCAT, nursing students are learning practical pharmacology (drug interactions, contraindications, etc.) and then in the masters (doctorate) program they get another more detailed pharmacology course.
5. I know of no community colleges who grant masters in nursing practice or even bachelors in nursing for that matter (although I am sure there are some that have bachelors programs).

For those of you who want to understand market dynamics, you should read The Innovator's Dilemma as it details how those in the high end of markets (MDs in this case) move higher for better margins and those in lower end (PAs/NPs) move in to take their place. Why doesn't IBM make laptops anymore...better money being business advisors to tech companies and Toshiba, Dell, and others moved in to fill the gap.

It is a fact that the FP physician will be usurped by the PAs/NPs eventually. And don't think that the government will keep them from it as a result of lobbying. Legislators have to keep the cost of healthcare down and will do whatever is necessary in the long run (see the post about Ohio PAs).

Moral of the story: Don't go into family practice if you want the "prestige" of being a "doctor" as probably within the span of your career (think 20-30 yrs) you will be seen as equal to PAs and NPs in that field.

Let's see...let's see....place this side down, microwave on "high" for three minutes or until popping stops...OK....diet coke chilled....got my comfortable chair....OK...I'm ready for the fireworks.

Come on. You know you're out there. The longer you resist posting the higher your risk of blowing an aneurysm.
 
Let's see...let's see....place this side down, microwave on "high" for three minutes or until popping stops...OK....diet coke chilled....got my comfortable chair....OK...I'm ready for the fireworks.

Come on. You know you're out there. The longer you resist posting the higher your risk of blowing an aneurysm.

I think that family docs won't necessarily get replaced by PAs and NPs, but there will def be less demand for them. You'll always need some MDs around for the harder cases, but the midlevels will be able to do most of what the family doc does. However, I think that the family docs will likely stop this shift via lobbying or whatever.
 
I think that family docs won't necessarily get replaced by PAs and NPs, but there will def be less demand for them. You'll always need some MDs around for the harder cases, but the midlevels will be able to do most of what the family doc does.

My point exactly. There will always be FP physicians but there will be more and more PAs and NPs filling these roles.

I wasn't saying that FP physicians are less of an MD, just that the prestige will probably be lost in the future.
 
You are way out of touch with reality if you believe PA's will replace MD's just because it is cheaper. You get what you pay for.

The reason PA's are accepted in healthcare is because they do not approach patients saying "I am not an MD, but I can treat you anyways". I would venture a guess that if PA's presented themselves not as a doctor, then patients wouldn't put up with it (generally speaking). The patient would rather see the guy with the MD degree than a PA degree. The patient-physician relationship is deeply integrated in our society and patients respect this.

The fact that a patient can see a PA and not ever know they are not an MD is dangerous. Seems like deception to me.
 
My point exactly. There will always be FP physicians but there will be more and more PAs and NPs filling these roles.

I wasn't saying that FP physicians are less of an MD, just that the prestige will probably be lost in the future.

Soonereng:From what I can see FPs and PCP in general have already lost a lot of the prestige that they used to have~from an administrative and academic view.[Admittedly this is from a third year medical student's perspective~so what the heck do I know]. Managed care and insurance plans have broken down a lot of the continuity that used to be the hallmark of a PCP's relationship with their patient. Also, PCPs seem to get the scutwork of the other specialist in terms of dealing with paperwork, insurance forms, etc. I think that makes PCP's 'looked down on' by other physicians. They work long hours and get paid little and they're always being told to schedule more patients and get through them in less time.

However, they also have the best opportunity to practice the best sort of medicine (ie preventative) and really can make a difference. For the most part, it seems PCPs don't go in it for the money or prestige. They go into PC to provide the best sort of patient care. And I'm sorry, that care isn't going to be given by the average NP/PA acting alone ~no matter how smart that person is. Medical education is longer and more vigorous than any NP/PA program ~flame me if you like~and the finished products show it.

Besides that, I think it really matters to people that they get to see a doctor. I was amazed during my rural FP rotation to see how much people valued 'their' doctor. And I know for a fact that they would not have been satisfied seeing a NP or PA. Maybe its different in a larger city where people just schedule an appointment with whoever they can get, but I'm not so sure. That kind of prestige I don't believe will be taken away no matter how many NP/PAs glut the market.
 
You are way out of touch with reality if you believe PA's will replace MD's just because it is cheaper. You get what you pay for.

The reason PA's are accepted in healthcare is because they do not approach patients saying "I am not an MD, but I can treat you anyways". I would venture a guess that if PA's presented themselves not as a doctor, then patients wouldn't put up with it (generally speaking). The patient would rather see the guy with the MD degree than a PA degree. The patient-physician relationship is deeply integrated in our society and patients respect this.

The fact that a patient can see a PA and not ever know they are not an MD is dangerous. Seems like deception to me.

My only experience being treated by a PA was very positive. The GP presented her a "doctor just like an MD except without the residency." I dare say I prefered her slightly over the MD in this particular case (having been seen by the MD a few times as well), although both are highly respected and competent from what I can tell. She was more professional and competent than many MD's I've run across in similar situations. She was very "by the book" and seemed to be very detail minded, quick, and smart in covering all the possibilities. She initially guessed what turned out the confirmed diagnosis but went through all the steps to confirm that and rule out other possibilities.

She referred me to a specialist and he told me exactly the same thing that the PA told me almost word for word. However, then the specialist told me there was a "short/less rigorous" way (essentially trying a particular drug based on the symptoms and prior test results) and a "long/more rigorous" way of diagnosing this ... which one would I preferred. I picked the short way and it worked out for me.

I won't begin to claim that my experience is typical or representative, but thought it might be worthwhile to contribute another datapoint (which very well could be an outlier). I know there are plenty incompetent PA's out there and that PA's have their limits both in terms of training and in terms of what they are allowed to do.
 
The fact that a patient can see a PA and not ever know they are not an MD is dangerous.

But the fact is that PAs and NPs see patients every day and the same plan of care is implemented as would be if they had seen the MD. The reason that they do not know that they aren't MDs is because they are treated just as they would have been had they seen the MD.

A bill was introduced in Congress (by a Rep. from Oklahoma I believe) that would prevent people from being called "Doctor" if they weren't an MD or DO. Lobbying in action. I know of no PAs or NPs who call themselves "Doctors" even though their patients may. My wife introduces herself as an NP and asks the patients if they know what that is, if not, she explains. She also has patients that say they would rather see her than an MD because she actually listens and explains.
 
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